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Per Diem Risk Adjustment Specialist Jobs (NOW HIRING)

MetroPlusHealth

Risk Adjustment Specialist

Manhattan, NY · Hybrid

$72K - $82K/yr

As a Risk Adjustment Specialist, you will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate ...

New

MetroPlusHealth

Risk Adjustment Specialist

Manhattan, NY · On-site

$72K - $82K/yr

As a Risk Adjustment Specialist, you will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate ...

New

The Alliance

Risk Adjustment Director

California, MO · On-site

$200 - $250/hr

... services, and specialist services * Develop, plan, organize, and direct finance programs and ... Ample Paid Time Off * 12 Paid Holidays per year * 401(a) Retirement Plan * 457 Deferred ...

Sentara Health

Risk Adjustment Coder

Virginia Beach, VA · Hybrid

$10K/mo

Risk Adjustment Coding & Documentation Specialist, Talroo-Allied Health, Medical Office Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision plans • Adoption, Fertility and ...

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Job Summary Our client is seeking a skilled Risk Adjustment Director to serve as the executive ... Eligibility for health benefits is based on verifying that an average of 30 hours per week during ...

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Per Diem Risk Adjustment Specialist information

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$38K

$100.5K

How much do per diem risk adjustment specialist jobs pay per year?

As of Aug 9, 2026, the average yearly pay for per diem risk adjustment specialist in the United States is $94,940.00, according to ZipRecruiter salary data. Most workers in this role earn between $98,500.00 and $98,500.00 per year, depending on experience, location, and employer.

What is a per diem risk adjustment specialist?

A Per Diem Risk Adjustment Specialist is a healthcare professional who works on an as-needed basis to review and analyze patient medical records for accurate documentation and coding. Their primary role is to ensure that diagnoses are properly captured for risk adjustment purposes, which affects healthcare reimbursement and quality measures. They often work remotely or on-site for healthcare organizations, focusing on compliance with regulatory standards and accuracy in coding practices. This position requires detailed knowledge of medical coding, risk adjustment models, and healthcare regulations.

What are the key skills and qualifications needed to thrive as a per diem risk adjustment specialist?

To thrive as a Per Diem Risk Adjustment Specialist, you need a solid understanding of medical coding (ICD-10), health information management, and risk adjustment methodologies, typically supported by a coding certification such as CPC or CRC. Familiarity with electronic health records (EHRs), coding software, and risk adjustment platforms is essential for accurate data capture and reporting. Strong attention to detail, analytical thinking, and effective communication skills help ensure the integrity of clinical documentation and collaboration with providers. These skills are crucial for optimizing reimbursement, supporting regulatory compliance, and contributing to accurate patient risk profiling in healthcare organizations.

What are some common challenges faced by per diem risk adjustment specialists, and how can they be addressed?

Per Diem Risk Adjustment Specialists often face the challenge of managing fluctuating workloads and adapting quickly to different healthcare settings or documentation systems. Since the role typically involves reviewing medical records for accuracy and completeness, staying updated on coding guidelines and payer requirements is crucial. To succeed, it's helpful to maintain strong organizational skills, be proactive in continuing education, and communicate effectively with permanent staff to clarify documentation or coding questions. Flexibility and attention to detail are key assets for overcoming these challenges and ensuring accurate risk adjustment reporting.

What is the difference between Per Diem Risk Adjustment Specialist vs Per Diem Claims Processor?

AspectPer Diem Risk Adjustment SpecialistPer Diem Claims Processor
Primary FocusAnalyzing and optimizing risk adjustment data for health plansProcessing daily insurance claims and payments
Required CredentialsKnowledge of healthcare coding, risk adjustment, and data analysisUnderstanding of claims processing and insurance policies
Work EnvironmentHealthcare offices, insurance companies, or remoteInsurance companies, healthcare providers, or remote
Industry UsageCommonly used in health insurance and risk adjustment sectorsUsed across insurance claims processing departments

The Per Diem Risk Adjustment Specialist focuses on analyzing risk data to improve health plan reimbursements, while the Per Diem Claims Processor handles daily claims processing tasks. Both roles are essential in healthcare insurance operations but differ in their core responsibilities and skill sets.

More about Per Diem Risk Adjustment Specialist jobs
What cities are hiring for Per Diem Risk Adjustment Specialist jobs? Cities with the most Per Diem Risk Adjustment Specialist job openings:
What are the most commonly searched types of Risk Adjustment Specialist jobs? The most popular types of Risk Adjustment Specialist jobs are:
What states have the most Per Diem Risk Adjustment Specialist jobs? States with the most job openings for Per Diem Risk Adjustment Specialist jobs include:
What job categories do people searching Per Diem Risk Adjustment Specialist jobs look for? The top searched job categories for Per Diem Risk Adjustment Specialist jobs are:
Per Diem Risk Adjustment Specialist jobs near you
Infographic showing various Per Diem Risk Adjustment Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, and 3% Contract. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution, with an average salary of $94,940 per year, or $45.6 per hour.

Risk Adjustment Specialist

MetroPlusHealth

Manhattan, NY • Hybrid

$72K - $82K/yr

Full-time

Posted 3 days ago

New

MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

264th of 304 rated insurance

Job description

Position Overview

Risk Adjustment is a growing and critical field within Health Insurance Finance. This is your opportunity

to support this function at MetroPlusHealth, New York City’s not-for-profit health insurance company. As a Risk Adjustment Specialist, you will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate information to federal and state agencies. You will work independently to monitor and support internal partners and external vendors in data collection and submission. You’ll apply your problem-solving skills to resolve issues you identify. You will also calculate errors and acceptance rates to track progress over time.

This opportunity is ideal for an individual interested in working at the intersection of Health Insurance Analytics and Operations, who excels at creative problem solving, is detail-oriented, and who is committed to our mission of providing access to health insurance to all New Yorkers.

Scope of Role and Responsabilities 

  • Ongoing monitoring of data submitted by vendors to ensure project goals are being met,
  • submitted data is complete and accurate, and errors are identified quickly.
  • Proactively work with external and internal partners to resolve issues – this includes identifying the root cause, devising plans to remediate, and ensuring on-time completion from all stakeholders.
  • Support end-to-end submission processes and encounter data across all lines of business, including Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines, resubmissions, and validating accepted and rejected encounter metrics to ensure data is accurately reflected in downstream reporting.
  • Perform financial impact analysis of Risk Adjustment activities, including implications of data errors, missed submissions, and remediation efforts.
  • Access and analyze data within the enterprise data warehouse to evaluate member, provider, claims, and enrollment data in support of Risk Adjustment and encounter data initiatives.
  • Utilize dashboards to identify trends and potential opportunities in data collection and reportng. 

Required Education, Training & Professional Experience

  • Bachelor’s degree required, with a demonstrated interest in Finance, Social Services or Health Care.
  • Minimum of 3-4 years’ experience required working for a Health Plan, or in a Finance, Project Management or Actuarial capacity in another industry.
  • Ability to work independently to investigate, pinpoint, and resolve problems.
  • Strong analytical and financial skills. Experience using SQL, R, SAS or another programming language is a plus.
  • Proactive communication style and ability to work with a variety of stakeholders to achieve project goals.

Professional Competencies 

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication

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